California Hospital Nurses Need your Input please!!

[hdhnurse]

Hi all,

I would like some specifics on the nurse patient ratio in hospitals in California. How is a typical med surg floor staffed? Do you have 5 patients and an assistant? Or do you have 5 patients and primary care? Do you have a HUC and do you have a tele monitor tech?

I am asking this question specifically because I work in a small rural hospital...Our medsurg floor is totally comprehensive with tele patients, pediatrics, geriactrics, post op, general illnesses and what they like to call "critical care" Which would include vents.

My hospital is currently raising our nurse patient ratio and we are being told to suck it up.....Acuity does not matter and on any given day I can have 7-8 patients that would include a cardizem gtt, nitro gtt, pediatric asthma, fresh post-op, confused geriactric etc..... you get the idea. We do have nursing assistants and we have one HUC/monitor tech that is responsible for taking off orders and reading tele monitors.

Nurses are receiving flyers in the mail about the RN nurse to patient ratio laws that are enacted in California and someone brought the flyer to work and posted it on our bulletin board.....Our nurse manager had a fit and wrote a memo that said we didn't know what we were talking about....that all California nurses are primary care now and that they have to do their own orders and read their own monitor strips.....That we are lucky to be staffed the way we are and we should be careful of what we asked for...

So to all California RNs ....What's the scoop? How are they staffing your floors?

Thanks

[suzanne4, RN]

Ratio laws are determined by the majority of the patients on the unit that day when it comes down to it. If more than 50% are tele, then the unit is staffed that way. If less than 50%, it can be staffed with med-surg ratios.

We are seeing a decrease in the number of facilities that are using CNAs since the rations were just lowered as of January 1 on the med-surg and tele units. ER and critical care have remained the same.

Depends on the facility in CA, but most that I am aware of still have secretaries as well as monitor techs, the nurses do do primary care in most instances; but they do not take off their own orders. Sure, off shift may not provide a secretary as the orders can be less in number, but then the charge nurse will usually do them.

For you to have that number of patients and the drips that need close monitoring, it is an accident waiting to happen. Patients can code and do other ugly things in rural facilities as well as the larger teaching hospitals in major cities across the country.

Not sure how much your assistants can do to help you or where you are located. But having a critical care patient on a vent, as well as six other patients is just not safe. No matter what your manager tells you.

Where are you located? I have worked rural medicine and have not seen what you are describing in many years.

Will move this to the CA forum since you are specifically asking for input from the nurses in this state.

[hdhnurse]

Suzanne,

I work in a rural part of southern Ohio....Our hospital is going through some major "financial" trouble or so they say....We are being pushed to the max and all the nurses are just about at their wits end.

Acuity just does not matter in the assignment...Heck when I left work tonight the night shift nurses were going to have about 8 patients a piece, a cardizem gtt was coming up from ER....There were about 4 chest pains r/o MIs on the floor, a bunch of COPDers, one who was looking pretty critical and several confused patients on bed alarms that like to climb out of bed all the time.

The NA's on night shift would probably end up with 11 or 12 a piece and the nurses with 8 a piece.

I depend on my nursing assistant to be my eyes and ears when I am too busy to get into a room as often as I like....But it seems they are slowly trying to phase out the NA's now too...

We are so frustrated and so scared that something really bad is going to happen. I have worked at this facility for over 10 years and have never seen it this bad!!

[suzanne4, RN]

Something bad is going to happen and you have reason to be concerned.

Have you tried to contact your government agencies over this? And if all else fails, the newspapers and television stations in the area are always willing to do a story on this.

When something does happen, and it will with what they are trying to do, the administration will not have anything to worry about. A patient will be owning the facility and they will be out of their jobs.

Shame on them. Wonder what they would be doing or requesting if they became the patient there with those numbers? Or do they go someplace else for care?

[Haunted]

California worked very hard to enact the ground breaking ratio laws. Many nurses lost their jobs for speaking up on behalf of this new regulation. In the end, the well known California Nurses Association lobbied Goverment regulators, many nurses went on strike and much attention was finally gained in regards to how this ratio would impact not only patient safety but employee retention.

Some facilities in California were already unionized and had ratios in place, Kaiser Permemente being the largest example. Although hospitals were not required to endorse or adopt Union coverage, the ratios were voted in by Congress. Not much follow up has been done since then. As I was told, being on the front lines and working closely with Union organizers who saw this as an opportunity to infiltrate facilities at this time ( I am neither for or against Unions) the ratios were put in place specifically to protect patients.

I feel that the ratio law is truly a groundbreaking move. I would love to see more research conducted in regards to outcomes. On a personal note, I have suffered incredible hardships from "sore loser" facilities that throw 5 high acuity patients my way during a shift without a CNA. That little CNA codicle was clearly overlooked and many a seasoned nurse has commented that the ratios should be based on patient acuity.

Imagine if you will, you arrive on a typical Med Surg unit for your shift. You receive report on your 5 patients. 2 are on restraints, 1 is on 1 to 1 monitoring for pulling tubes, getting out of bed, etc. 1 is on a cardio drip on a monitor and finally 1 is a walky talky independant. There may, by the grace of the staffing department be 1 tech on the floor/ They are not legally obligated to provide you with ANY support.

There is much to be considered and worked with in regards to staffing ratios. I do believe they can work. I do believe they provide the most favorable outcome for patient survival. We need an innovator who can assess outcomes vs. acuity.

I am a Registered Nurse. I work bedside. I have no problem changing lines, turning, mouth care, foley care. cleaning up any mess a patient can throw at me. If I am lucky to have a clinical partner, CNA, whatever they can count on me working side by side to get that patient clean and comfortable. I learn a lot from them and I always have their back. I keep my coworkers safe and my patients safe and comfortable.

Without a CNA, my day is longer, I have little support. In between delivering food trays, emptying FC's, recording I and O's and documenting ADL's for that patient I have little time to document my nursing objectives, outcomes and I am fragmented and frustrated providing services to a patient that could easily be delegated to someone better qualified and more goal directed than I am.

I find myself having to do several jobs at once. I need the support of my clinical team, whether it's the respiratory team, physical therapy, wound care, tele monitor tech or CNA, they are all respected member of the ultimate goal, to get that patient treated safely and eventually discharged home with as much education, teaching and followup that we can all provide.

As it is said in the fabled nursery rhyme, the cheese (RN) stands alone.

[hdhnurse]

My hospital is governed by a board made up of township trustees......I believe a lot of things are kept hidden from the board by admin. When we have a board member as a patient we do everything we can to try to get the to see how dire the situation is. ....I don't know if it will help or not.

We are also in fear of out jobs....They have been threatening layoffs for a few months...Nurses are getting wrtiten up for stupid stuff ( they forgot to fill a line on the pain flow sheet, forgot to address a pneumo vaccine on a patient, etc.) It's kind of like they are building files on each one of us so that the ones with the worst files will go first when the ax falls....

I used to love my job and was proud of where I worked....Now it takes everything I have to get through the day.... I work in fear and frustration....And no one cares.

Those of us that speak up are quickly stifled with threats and write ups.....I need my job because I am the sole supporter of my family.

But it's a terrible way to work.